Development of customized fetal growth charts in twins

Ghi, T.; Prefumo, Federico; Fichera, A.; Lanna, M.; Periti, Enrico; Persico, Nicola; Viora, E.; Rizzo, Giuseppe; Arduini, D.; Arduino, S; Aiello, Elisa; Boito, Simona; Celentano, Claudio; Chianchiano, N.; Clerici, Graziano; Cosmi, Erich; D’Addario, Vincenzo; Pietro, Chiara Di; Ettore, Giuseppe; Ferrazzi, Enrico; Frusca, T.; Gabrielli, S.; Greco, Pantaleo; Lauriola, I.; Maruotti, Giuseppe Maria; Mazzocco, A.; Morano, Danila; Pappalardo, Elisa; Piastra, A.; Rustico, Maria Angela; Todros, Tullia; Stampalija, Tamara; Visentin, S.; Volpe, N.; Volpe, P.; Zanardini, C.

doi:10.1016/j.ajog.2016.12.176

Cited by 45 publications

(78 citation statements)

References 32 publications

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“…Our results are similar to those recently reported by Ghi et al [8], in which customized charts were created from retrospective data excluding cases with fetal complications and poor pregnancy outcomes. Our study differs from the previous mainly because of its prospective design and the exclusion criteria.…”

Section: Discussionsupporting

confidence: 81%

“…For EFW, Table 6 shows the 10th, 50th, and 90th centiles at 24, 30, and 36 weeks of gestation from our results, Ghi et al [8], and Shivkumar et al [21]. …”

Section: Resultsmentioning

confidence: 90%

“…We also created charts showing the 5th, 50th, and 95th centiles for each biometric parameter, from our results and the series developed by Ghi et al [8] and the STORK group [7], at 24, 30, and 36 weeks of gestation (Tables 2-6). For EFW, Table 6 shows the 10th, 50th, and 90th centiles at 24, 30, and 36 weeks of gestation from our results, Ghi et al [8], and Shivkumar et al [21].…”

Section: Resultsmentioning

confidence: 99%

“…Recent series of growth reference charts for dichorionic and MC pregnancies show that MC twins have a lower adjusted birthweight than dichorionic twins when compared to singletons [7, 8]. The significant independent effect of chorionicity on birthweight suggests that MC placentation in itself has an effect on intrauterine growth and discordance [9, 10].…”

Section: Introductionmentioning

confidence: 99%

“…The most accepted diagnostic criteria are an estimated fetal weight (EFW) <10th percentile and an intertwin weight discordance ≥25% [8]; however, usually no specific charts for MC pregnancies are used for EFW centile estimation. Although several studies have documented a progressive reduction in fetal growth in twin pregnancies compared to singletons, especially in the third trimester of pregnancy, most centers have reported the use of singleton pregnancy reference charts for multiple gestations [7, 8]. …”

Section: Introductionmentioning

confidence: 99%

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Gender-Specific Antenatal Growth Reference Charts in Monochorionic Twins

et al. 2017

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Objective: To create antenatal gender-specific reference growth charts in uncomplicated monochorionic diamniotic twins. Materials and Methods: This is a prospective longitudinal study in which uncomplicated monochorionic (MC) twin pregnancies were included from 23 + 4 weeks of gestation onwards. Estimated fetal weight (EFW) and biometric parameters (biparietal diameter, head circumference, abdominal circumference, and femur length) were evaluated in both fetuses every 2 weeks using standardized methodology. Maternal and fetal complications were excluded. Charts were fitted for each biometric parameter and EFW in relation to gestational age and fetal gender using multilevel mixed models. Results: The final analysis included a total of 456 ultrasound examinations in 62 MC twins, with a mean of 7 scans per pregnancy (range 5–8). The mean as well as 5th and 95th percentiles of each biometric parameter and EFW were adjusted in relation to gender and gestational age between 24 and 37 weeks of gestation. Male fetuses have higher reference values than females, and the disparity is larger in the upper centiles of the distribution. Discussion: We provide gender-specific reference growth charts for MC twins. We suggest that these charts will improve prenatal MC twin assessment and surveillance, with a more accurate classification of normal or growth-restricted fetuses adjusted per sex.

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Section: Discussionsupporting

confidence: 81%

“…For EFW, Table 6 shows the 10th, 50th, and 90th centiles at 24, 30, and 36 weeks of gestation from our results, Ghi et al [8], and Shivkumar et al [21]. …”

Section: Resultsmentioning

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gender-Specific Antenatal Growth Reference Charts in Monochorionic Twins

et al. 2017

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Left myocardial performance index in monochorionic diamniotic twin pairs complicated by selective fetal growth restriction with abnormal umbilical artery Doppler

et al. 2021

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Objective To evaluate left myocardial performance index (MPI) and its time intervals in monochorionic diamniotic (MCDA) twin pairs complicated by selective fetal growth restriction (sFGR) with abnormal (persistent ‐type II‐ or intermittent ‐type III‐ absent or reversed end‐diastolic flow) umbilical artery Doppler. Methods Retrospective study including 16 MCDA twin pairs with sFGR type II, 26 MCDA twin pairs with sFGR type III and 42 gestational age‐matched uncomplicated MCDA twin pairs in a single tertiary center. Left isovolumetric contraction time (ICT), ejection time (ET), and isovolumetric relaxation time (IRT) were measured and MPI calculated by conventional Doppler at diagnosis of sFGR. Results In sFGR type II, the smaller twin had shorter ET and prolonged IRT and MPI, while the larger twin showed prolonged ICT and MPI as compared to uncomplicated MCDA twins. In sFGR type III, the smaller twin had shorter ICT and ET, while the larger twin showed prolonged ICT, IRT, and MPI in comparison to controls. Conclusion A differential pattern of MPI time intervals could be observed in MCDA twins with sFGR type II and III. All twins had echocardiographic signs of pressure/volume overload, except the smaller twin type III with shorter systolic times probably reflecting reduced volume load.

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Cerebro‐placental and umbilico‐cerebral ratios in uncomplicated monochorionic twins: Longitudinal references and comparison with singletons

et al. 2022

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Objectives: Monochorionic twins (MC) are at high risk of adverse outcomes and Doppler investigation of umbilical and cerebral flows is mandatory for their surveillance. The cerebro-placental (CPR) and umbilico-cerebral (UCR) ratios are considered non-invasive measures of fetal adaptation to hypoxemia. We aimed to provide longitudinal references for CPR and UCR from 16 to 37 weeks of gestation that are specific for MC twins, and compare these with singleton charts.Methods: Longitudinal study of a cohort of consecutive uncomplicated MC twin pregnancies monitored at our unit from 2010 to 2018. The estimated centile curves were obtained estimating the median with fractional polynomials by a multilevel model and the external centiles through the residuals. The comparison with singletons references was made through graphic evaluation.Results: One-hundred-fifty-two MC pregnancies were included with a median of 10 longitudinal ultrasounds each. References for CPR and UCR in function of gestational age are presented. Compared to singletons, MC twins showed an earlier and greater circulatory redistribution with lower CPR and higher UCR median values.Conclusions: MC twin-specific references for CPR and UCR suitable for serial monitoring are presented. The comparison with singleton references demonstrates substantial differences in the hemodynamic balance that must be considered when interpreting findings in MC twins. Key pointsWhat's already known about this topic? � Uncomplicated monochorionic twins have higher umbilical flow and lower cerebral flow resistances compared to singletons, especially at increasing gestational ages. What does this study add?� Monochorionic twins-specific longitudinal references for cerebro-placental and umbilicocerebral ratios from 16 to 37 weeks are reported.� Compared to singletons, uncomplicated monochorionic twins exhibit earlier and greater centralization of blood flow.Twins congress live online congress, 4-6 June 2021.

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Development of customized fetal growth charts in twins

Cited by 45 publications

References 32 publications

Gender-Specific Antenatal Growth Reference Charts in Monochorionic Twins

Gender-Specific Antenatal Growth Reference Charts in Monochorionic Twins

Left myocardial performance index in monochorionic diamniotic twin pairs complicated by selective fetal growth restriction with abnormal umbilical artery Doppler

Cerebro‐placental and umbilico‐cerebral ratios in uncomplicated monochorionic twins: Longitudinal references and comparison with singletons

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